Humana Chief Medical Officer Roy Beveridge, M.D., was meeting with a provider earlier this month when the organization’s CEO said something he’d been waiting to hear.
“You know, I don’t think of Humana so much as an insurance company as an IT company who is helping us with the data that we need in order to deal with our population health tools,” the CEO said, according to Beveridge.
As it so happens, that’s precisely how Beveridge views his company’s role in an increasingly value-driven payment world. Humana, one of the nation’s largest health insurance companies that specializes in Medicare Advantage plans, sees itself as a critical data partner for providers in an era where more comprehensive data is becoming an invaluable tool. Humana’s approach relies on putting previously inaccessible information—like how often a patient filled their prescription or which diabetes patients also suffer from a behavioral health condition—in front of physicians and providers to improve care and drive value.
“Sometimes I think we’re becoming more of a data analytics company than anything else,” Beveridge said in an exclusive interview with FierceHealthcare.
These kinds of data partnerships were virtually impossible in a fee-for-service environment that pitted payers and providers against one another. Insurers were tasked with sniffing out overutilization, while providers lacked any financial incentives to prevent unnecessary admissions. Currently, 64% of Humana’s Medicare Advantage members are in value-based payment contracts, and Beveridge said data and analytics play a critical role in insuring that those contracts provide physicians with an opportunity to succeed.
Below are some of the highlights from FierceHealthcare's conversation with Beveridge.
Editor’s Note: The following has been lightly edited for length and clarity.
FierceHealthcare: You say providers see you as more of a health IT company. Do you look at yourselves that way? Is that a role you’ve embraced?
Roy Beveridge: Increasingly, our role is to support the value-based physician. If you’re going to take that point of view, working with them and helping them understand what their data shows and what our data shows, it all becomes one. Then you begin to optimize care for their patient, our member.
It’s kind of a mindset difference. If we begin to acknowledge that their patients are our members and that we have a completely aligned interest, then things go well. Remember, in the fee-for-service world you don’t have that alignment.
FH: You’re at 64% value-based payment contracts right now. What’s stopping you from getting to 100%?
RB: With MACRA, all the doctors are saying, “I want to get into risk as quickly as possible.” Here’s what we’ve learned over the past 10 years: Unless you spend time teaching the physician how to do this and get into value relationships, they are going to fail.
In order to be successful in a value relationship, you can’t see a patient for 12 minutes twice a year. You actually have to see them for about half an hour, six to 12 times per year. If the mindset is, I can just do this because I’m a good doctor, they are going to fail because they are still doing things in a fee-for-service manner.
They have to learn how to use the data analytics we’re giving them. They have to say, "This data is really important because it is telling me which patient I need to pay attention to within the population"—if they don’t learn that, they’re not going to be successful. Data and analytics are what drives the intelligence which allows them to be the best doctors they can be.
FH: What do you see as the biggest challenge for payers in terms of not just getting that data in front of physicians but making it actionable?
RB: Physicians have to have information that is actionable that they see in their EHR or is literally put in front of them, and EHRs tend not to do that at this point. We designed something to get it into the EHR, but you also have to be careful you don’t have alert fatigue.
We have to figure out a good balance between feeding people data and having actionable data. We’ve got the technology to get all the data there, it’s a question of having the intelligence to present it so people can prioritize and take action with it. We, and others, are still trying to figure out what is the best way of doing that.
I don’t want you to think we’ve got this figured out. We’ve got it figured out better than most, but we still recognize that what works in Florida might not work in Chicago. Medicine is local, and you have to figure out what works in particular areas and for particular groups of people.
FH: You say you’ve got it figured out better than most. What is Humana doing that is different, or better, than the rest of the industry in terms of using data?
RB: I think that we’ve got a better line of sight to understand clinicians. We’re working with providers to understand what’s the best way of supporting them. Other insurers are sitting there talking about how they can do things for their members and do things for themselves. What you keep hearing from us is how can we do things to help our providers do better. If the providers do better then our members are being treated better, and that’s ultimately what we need to have.
FH: Is there something that allows you, as a company, to have that perspective?
RB: In part, we’ve been doing it longer than most, so we really do understand risk. We understand this concept of value. We recognize that it’s the long-term relationship with providers that is important. We could give value and risk to a whole bunch of folks right now—that other 36%—but I don’t think they’d do very well. That’s not good for our member, it’s not good for that patient and it’s certainly not good for the provider.
Other people will say, “We’ve got the best IT systems.” Our IT systems are pretty good. It’s the difference between an iPhone 6 and an iPhone 7—they are both pretty darn good. The question is how do you use it. It’s not a pure IT game; it’s how you use it and with whom you use it.